Our Kidney Transplant results in morbid obesity patients

INTRODUCTION: Obesity is a major cardiovascular risk factor (CVRF). Metabolic disorders such as hypertension, insulin resistance, dyslipidemia, and atherosclerosis are associated with CVRFs, Although kidney transplantation reduces the risk of death and cardiovascular events associated with dialysis, cardiovascular disease remains one of the leading causes of death in kidney transplant recipients.
METHODS: Five patients with a BMI ≥40 from 47 living donor renal transplant recipients were included in the study. 2.5 mg/kg of antithymocyte globulin (ATG) in induction and tacrolimus, steroid and mycophenolate mofetil (MMF) as maintenance therapy were given to all patients.. Operation times, end-stage renal disease etiologies, posttransplant early graft functions and hospital stay of the patients were evaluated.
RESULTS: Four patients were male and 1 was female. The kidneys of all patients were placed in to the right iliac fossa. The mean operative time was 3 hours, and the mean hospital stay was 10 days. Acute humoral rejection was observed in 1 patient in the biopsy performed due to elevated creatinine levels on the 7th postoperative day. The mean exit creatinine value was found to be 1.2 mg/dl. Lymphocele requiring drainage was detected in 2 of 5 patients in the early postoperative period.
DISCUSSION AND CONCLUSION: Obesity is a risk factor for the development of complications in kidney transplant patients. Kidney transplantation has a survival advantage in obese patients compared with the patients on dialysis. A public health campaign is needed to raise awareness and to emphasize the importance of self-care, increased exercise, healthy eating and weight loss in kidney transplant candidates.

Morbid Obez Hastalarda Böbrek Nakli Sonuçlarýmýz

GÝRÝÞ ve AMAÇ: Obezite majör bir kardiyovasküler risk faktörüdür (KVRF). Hipertansiyon, insülin direnci, dislipidemi ve ateroskleroz gibi metabolik bozukluklar KVRF'lerle iliþkilidir ve böbrek nakli alýcýlarýnýn %75-80'inden fazlasý en az bir KVRF'ye sahiptir. Böbrek transplantasyonu diyaliz ile iliþkili olarak ölüm ve kardiyovasküler olay riskini azaltsa da, kardiyovasküler hastalýk böbrek nakli alýcýlarýnda önde gelen ölüm nedenlerinden biri olmaya devam etmektedir.
YÖNTEM ve GEREÇLER: Çalýþmaya canlý donör renal transplantasyon yapýlan 47 hastadan BMI ≥40 olan 5 hasta alýndý. Tüm hastalara indüksiyonda 2.5 mg/kg antitimosit globülin (ATG), idame tedavisi olarak takrolimus, steroid ve mikofenolat mofetil (MMF) verildi. Hastalarýn operasyon zamanlarý, son dönem böbrek yetmezliði etiyolojileri, posttransplant erken graft fonksiyonlarý ve hastanede kalýþ süreleri deðerlendirildi.
BULGULAR: Böbrek nakli yapýlan ve çok morbid obez hastalarýn (Body Mass Index (BMI)≥40) 4’ ü erkek 1’i kadýn hastaydý. Tüm hastalarýn böbrekleri sað iliak fossaya yerleþtirildi. Hastalarýn ortalama operasyon süresi 3 saat, ortalama hastanede kalýþ süresi 10 gün olarak bulundu. 1 hastada postoperatif 7. günde kreatinin yüksekliði nedeniyle yapýlan biyopside akut humoral rejeksiyon görüldü. Hastalarýn ortalama çýkýþ kreatinin deðeri 1.2 mg/dl olarak bulundu. 5 hastanýn 2’ sinde postoperatif erken dönemde drenaj gerektirecek lenfosel saptandý.
TARTIÞMA ve SONUÇ: Obezite, böbrek nakli yapýlan hastalarda intraoperatif ve postoperatif dönemde komplikasyon geliþimi için bir risk faktörüdür. Bununla birlikte birçok çalýþma böbrek naklinin obez hastalarda diyalize devam eden hastalara kýyasla sað kalým avantajý saðladýðýný göstermiþtir. Böbrek nakli adaylarýnda farkýndalýk yaratmak ve öz bakým, artan egzersiz, saðlýklý beslenme ve kilo vermenin önemini vurgulamak için bir halk saðlýðý kampanyasýna ihtiyaç vardýr.